| NPI | 1134162118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: MN 51662) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: MN 51662) |
| 208000000X Pediatrics (Licence: OR MD23404) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2017-12-21 |